Glossopharyngeal schwannoma causing vocal fold paralysis

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Evaluation of the concordance of sialometry and salivary glands scintigraphy in dry mouth patients

INTRODUCTION: Many diagnostic tests are used to evaluate dry mouth patients, especially the ones with Sjögren s Syndrome, to whom these tests are part of classification criteria for scientific studies. AIM: Thus, the concordance between results of sialometry and salivary glands scintigraphy was evaluated; if positive, it would enable the choice of one or the other for diagnosis. PATIENTS AND METHOD: Seventy-two dry mouth patients were divided into non-Sjögren s Syndrome group, primary Sjögren s Syndrome group and secondary Sjögren s Syndrome group. The concordance among sialometry and scintigraphy results was evaluated by Kappa test. RESULTS: It was observed that their concordance was equal or near to zero. CONCLUSION: It is not possible to make a choice between these tests and both should be performed.INTRODUÇÃO: São utilizados vários exames para avaliar os pacientes com queixa de boca seca e, especialmente, os pacientes com Síndrome de Sjögren, em que estes exames fazem parte de critérios de classificação para estudos científicos. OBJETIVO: Desta maneira, procurou-se avaliar se haveria concordância entre os resultados da sialometria e da cintilografia de glândulas salivares para, se esta concordância estiver presente, optar por apenas um dos dois exames. CASUÍSTICA E MÉTODO: Foram avaliados 72 pacientes com boca seca, divididos em grupos não-Síndrome de Sjögren, com Síndrome de Sjögren primária e com Síndrome de Sjögren secundária. Os resultados de sialometria e cintilografia de glândulas salivares foram estudados, procurando-se dimensionar a concordância existente entre eles, através do teste de Kappa. RESULTADOS: Observou-se concordância igual ou próxima de zero entre os dois testes. CONCLUSÃO: Pelos resultados observados, não é possível fazer a opção por um ou outro exame, devendo ambos serem realizados.Santa Casa de São Paulo F.C.M.Santa Casa de São Paulo F.C.M. Depto. de MorfologiaHospital Nossa Sra. de LourdesUNIFESPSanta Casa de São Paulo Faculdade de Ciências. Médicas Depto. de OtorrinolaringologiaUNIFESPSciEL

Arch of cricoid cartilage anatomical variation: morphological and radiological aspects

The cricoid cartilage serves asan anatomical reference for severa) surgical procedures for access to the airway. Additionally, it serves asan attachment point for muscles that move the vocal folds. We present a case where the cricoid cartilage arch is divided into distinct superior and inferior arches, with a fibrous membrane between them. We did not find any similar description to this case in the literature, which makes it unique to date. This type of variation is important knowledge for clinicians and surgeons during airway management in the anterior neck region. The presence of this variation could induce an error during a palpation of the thyroid and cricoid cartilages, realized in clinical examination and surgical or emergency procedure

Análise do pH salivar de indivíduos com Síndrome de Sjögren e refluxo laringofaríngeo pH salivary analysis of subjects suffering from Sjögren's Syndrome and laryngopharyngeal reflux

A saliva é fundamental para a homeostase digestiva. Alterações no seu volume e composição são correlacionadas com o refluxo laringofaríngeo (RLF). Estudos recentes demonstraram que pacientes com RLF apresentam acidificação do pH salivar. A síndrome de Sjögren (SS) foi eleita como modelo de hiposalivação, com objetivo de analisar as repercussões da diminuição salivar na laringe e faringe. CASUÍSTICA E MÉTODO: Estudo clínico transversal de 19 sujeitos com SS e RLF comparados com 12 indivíduos saudáveis. Obtidas amostras de saliva total não estimulada (STNE) e saliva total estimulada por mastigação de parafilm M® (STE). RESULTADOS: Todos os indivíduos eram mulheres, média de idade de 60 anos (estudo) e 44 anos. A prevalência de RLF foi 100%. O pH médio na STNE foi 7,53 (grupo estudo) e 7,57(controle), aumentando para 7,87 e 7,93, respectivamente, após estimulação mecânica. Não houve diferença significante de pH entre os grupos. O volume salivar médio dos pacientes com SS foi 1,27mL (STNE) e 3,78mL (STE), sendo o volume salivar do grupo controle significativamente maior (4,02mL na STNE e 11,96mL na STE). CONCLUSÕES: Todos os indivíduos estudados apresentaram RLF, fato provavelmente relacionado à queda uniforme observada no volume salivar e de todos seus componentes, não sendo observadas mudanças no pH salivar no grupo estudado. Isso sugere fisiopatogenias diferentes do RLF para indivíduos com SS.<br>Saliva is one of the components for the digestive homeostasis. Recent studies have shown that patients with laryngopharyngeal reflux (LPR) present a drop in salivary pH. Patients with Sjögren's syndrome (SS) are a potential clinical research model for xerostomia and its laryngeal and pharyngeal consequences. The aim was to evaluate the characteristics of saliva of patients with SS and LPR. METHODS: 19 patients with SS plus LPR, and 12 healthy controls had their saliva studied prospectively for volume and pH. Two salivary samples were obtained from each participant: whole unstimulated saliva(WUS) and whole stimulated saliva(WSS) while chewing parafilm M®. All the participants were females. RESULTS: Mean age was 60 years (study group) and 44 years (control). LPR was diagnosed on all 19 subjects. The mean pH of WUS was 7.53 (SS) and 7.57 (controls), raising to 7.87 and 7.83 respectively after stimulation. The mean salivary volume of patients with SS was 1.27 mL (WUS) and 3.78 mL (WSS), whereas controls had a significantly higher salivary volume both before and after stimuli. CONCLUSION: A very high prevalence of LPR was found in patients with SS, which is probably caused by a uniform drop in salivary volume and all its contents, rather than a specific deficiency in its components, as shown previously in patients without SS